Invoice Surgeon in Ivory Coast Abidjan –Free Word Template Download with AI
Department of Surgical Excellence
123 Boulevard de la République, Cocody
Abidjan, Ivory Coast
Tel: +225 27 22 44 55 66
Email: [email protected]
RC Abidjan B-2023-12345 | NIF: CI-9876543210
Invoice #: INV-2023-ABJ-8901
Date: October 24, 2023
Due Date: November 24, 2023
Reference: SURG-OP-445
Bill To:
Assurances Santé Côte d'Ivoire (ASCI)
Zone 4, Rue des Bananiers
Abidjan, Ivory Coast
Policy Holder ID: ASCI-998877
Patient Information:
Name: Jean-Marc Kouassi
Date of Birth: 15 March 1978
Admission Date: October 20, 2023
Discharge Date: October 23, 2023
| Description of Services | Code | Qty | Unit Price (XOF) | Total (XOF) |
|---|---|---|---|---|
|
Pre-Operative Surgical Consultation Comprehensive evaluation by the lead Surgeon in Abidjan to assess patient eligibility for the procedure. Includes review of medical history, physical examination, and risk assessment specific to the surgical intervention. |
SURG-001 | 1 | 150,000 | 150,000 |
|
Diagnostic Imaging & Laboratory Analysis Required pre-surgical diagnostics including MRI and blood panel analysis to ensure optimal surgical planning. Conducted at the Centre Médical de la Lagune facilities in Abidjan. |
DIA-005 | 1 | 200,000 | 200,000 |
|
General Anesthesia Administration Administration and monitoring of general anesthesia by a certified anesthesiologist during the surgical procedure. Includes pre-anesthesia assessment and post-anesthesia recovery monitoring. |
ANES-102 | 1 | 350,000 | 350,000 |
|
Complex Surgical Procedure (Laparoscopic Cholecystectomy) Primary surgical intervention performed by the Senior Surgeon. This fee covers the surgeon's professional time, technical expertise, and surgical skill required to perform the operation safely and effectively. |
OP-450 | 1 | 1,500,000 | 1,500,000 |
|
Operating Room Facility Fees Usage of the sterile operating theater, surgical instruments, and nursing staff support within the Ivory Coast Abidjan medical center. Includes sterilization and maintenance costs. |
FAC-010 | 1 | 450,000 | 450,000 |
|
Post-Operative Intensive Care (ICU) 24-hour monitoring in the Intensive Care Unit immediately following surgery. Includes vital sign monitoring, pain management, and immediate post-surgical care by specialized nurses. |
ICU-001 | 1 | 300,000 | 300,000 |
|
Pharmaceuticals and Medical Supplies Antibiotics, analgesics, intravenous fluids, and surgical consumables (sutures, dressings) administered during the hospital stay in Abidjan. |
PHAR-200 | 1 | 120,000 | 120,000 |
|
Post-Operative Surgeon Follow-Up Three scheduled follow-up appointments with the Surgeon to monitor wound healing, remove sutures, and ensure the patient's recovery is progressing without complications. |
SURG-003 | 3 | 50,000 | 150,000 |
Terms and Conditions & Payment Instructions
This invoice represents the professional fees for surgical services rendered by the Surgeon at Centre Médical de la Lagune in Abidjan, Ivory Coast. Payment is due within 30 days of the invoice date.
Payment Methods:
Bank Transfer: Ecobank Côte d'Ivoire
Account Name: Centre Médical de la Lagune
Account Number: 001-2233-4455-6677
IBAN: CI92 0012 2334 4556 6778 8990
SWIFT: ECOBCICI
Please reference Invoice #INV-2023-ABJ-8901 when making payment. Late payments may incur a penalty fee of 2% per month. If you have any questions regarding this invoice or the surgical procedure performed, please contact our billing department in Abidjan immediately.
Note: This document serves as an official receipt for tax purposes in the Republic of Côte d'Ivoire.
Authorized By:
Dr. Amina Diallo
Chief Surgeon
Centre Médical de la Lagune
Received By:
__________________________
Date: ____________________
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